CCMA cheat sheet

Normal adult vital signs: oral temperature 36.5-37.5 C (97.7-99.5 F), pulse 60-100 bpm, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100% on room air.

Injection sites: deltoid for vaccines (0.5 mL max, 90-degree angle, 22-25G, 1 inch); ventrogluteal is the safest IM site for adults and children over 7 months; vastus lateralis for infants.

Needle gauge rule: larger gauge number means smaller lumen. Use 21-23G for IM blood draws and injections of viscous fluid; 25-27G for subcutaneous and intradermal.

Intradermal injection uses a 26-27G needle at a 5-15 degree angle with the bevel up, creating a wheal; typical volume is 0.1 mL, as with TB skin testing.

Order of draw for capillary puncture: discard the first drop, then fill tubes in the same additive order as venipuncture; EDTA tubes are inverted 8-10 times, serum tubes without additive 5 times.

Universal precautions apply to all body fluids regardless of diagnosis; gloves are required for contact with blood, and hand hygiene is performed before and after glove use.

Medical asepsis reduces organism transfer (hand hygiene, clean gloves); surgical asepsis renders an object sterile and is required for urinary catheter insertion and dressing changes on sterile sites.

Chain of custody for a specimen requires documenting each person who handles it, with date, time, and signature; a break in the chain can invalidate the result in legal proceedings.

Normal ranges to recall: fasting glucose 70-99 mg/dL, adult hemoglobin 12-17 g/dL, hematocrit about three times hemoglobin, and adult resting respiratory rate 12-20 breaths per minute.

Scheduling math: a 15-minute slot holds 4 patients per hour; to calculate daily capacity, divide total provider minutes by average visit length and subtract blocked time.

Accounts receivable aging buckets are typically 0-30, 31-60, 61-90, and over 90 days; claims over 90 days are usually uncollectible and should be escalated.

CMS-1500 is the paper claim form for professional services; the UB-04 is used for institutional claims. Box 24 holds service lines, and Box 21 holds diagnosis pointers.

NPI is a 10-digit identifier with a check digit; the type 1 NPI identifies an individual, and the type 2 NPI identifies an organization.

EOB (explanation of benefits) is sent to the patient; the remittance advice (ERA/835) is sent to the provider. Both show allowed amount, adjustment, and patient responsibility.

Copayment is a fixed amount at time of service; coinsurance is a percentage of the allowed amount; deductible is the amount paid before the plan begins paying.

Release of information requires a written, signed authorization specifying the records, purpose, recipient, and expiration; psychotherapy notes require separate authorization.

Statute of limitations for medical debt and record retention vary by state; Medicare requires records be kept at least 10 years, and minors' records are typically kept until age of majority plus the state period.

Triage of incoming mail and faxes: date-stamp on receipt, route lab results to the provider before filing, and never discard a document until the provider has reviewed and initialed it.

Active listening means reflecting back content and feeling, asking open questions, and avoiding interruption; use it before offering solutions or education.

Therapeutic communication techniques include silence, restating, clarification, and offering self; nontherapeutic techniques include false reassurance, giving advice, and changing the subject.

Informed consent requires the provider to disclose risks, benefits, and alternatives; the medical assistant may witness the signature but may not explain the procedure in place of the provider.

HIPAA permits disclosure for treatment, payment, and operations without authorization; minimum necessary standard applies, and patients may request restrictions and an accounting of disclosures.

ADA accommodation process: the patient requests accommodation, the practice engages in an interactive process, and the accommodation must be effective but need not be the one the patient prefers.

Conflict resolution steps: address privately, use I-statements, focus on the behavior not the person, agree on a specific action, and document if the issue recurs.

Cultural competence includes using a qualified medical interpreter rather than a family member, avoiding assumptions about health beliefs, and confirming teach-back understanding.

Professional boundaries: do not accept gifts of significant value, do not discuss patients outside work, and refer personal requests for medical advice to the provider.

Documentation standards: objective, timely, factual entries with date, time, and initials; late entries are labeled as such, and errors are corrected with a single line and initials, never erased or whited out.